Healthcare Provider Details

I. General information

NPI: 1689547051
Provider Name (Legal Business Name): SY VUE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2025
Last Update Date: 09/24/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 RIVER PARK DR STE 404
SACRAMENTO CA
95815-4524
US

IV. Provider business mailing address

4521 RIO LINDA BLVD
SACRAMENTO CA
95838-2222
US

V. Phone/Fax

Practice location:
  • Phone: 916-567-1244
  • Fax:
Mailing address:
  • Phone: 916-825-0771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number84499
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: